Health

British Columbia sends patients to Seattle for coronary artery surgery: bypassing the queue in Canada

Article Abstract:

In contrast to the United States, Canada has a program of universal health insurance. But while the United States may look to the Canadian program for lessons in providing health care for the nation, Canada also looks to the US to provide some of its health care. The problem involves the system of queuing for elective surgery. To provide for the orderly delivery of services such as coronary bypass surgery, Canada instituted a first-come, first-served system which keeps people ''in line'' waiting for surgery to become available. The length of the wait has become so long that some have suggested that the queues are in actuality a form of rationing of services. The province of British Columbia on Canada's west coast entered into agreements with four hospitals in Seattle, Washington, to provide bypass surgery for 200 heart patients. An investigation revealed that the cause of the inability of Canadian hospitals to keep up with the demand for bypass surgery was not due to a lack of funding for the surgical procedure itself. Rather, the hospitals were not prepared to absorb an increase in the number of patients who would place increased demands on the facilities, since these patients would require not only surgery, but beds in the intensive care unit as well as recovery beds. Furthermore, there were occasional shortages of trained critical care nurses and technologists skilled in the necessary techniques of heart perfusion (keeping up the blood supply to the heart during the surgery). The situation reveals problems not in the funding of surgical procedures but in the investment of capital and the expansion of facilities. Another problem is revealed by the situation, however. There is an underlying tension between physicians and surgeons, on the one hand, and those who pay for their services on the other. Physicians tend to regard the long queues of people waiting for surgery as demand which is being unmet. In contrast, administrators may view the same queues as indications that physicians will always expand the delivery of health care until it meets the limits of facilities and funding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Author: Welch, H. Gilbert, Katz, Steven J., Mizgala, Henry F.

Publisher:American Medical AssociationPublication Name:JAMA, The Journal of the American Medical AssociationSubject:HealthISSN:0098-7484Year:1991

Canada, Social policy, Hospital waiting lists

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Telephone care as a substitute for routine clinic follow-up

Article Abstract:

Patients who receive follow-up care from their physicians over the telephone may use medical services less than those who receive follow-up care only at clinic visits. Of 497 men over 54 years old who were followed over a two-year period, 249 received follow-up care over the telephone in combination with clinic visits, and 248 received follow-up care only at clinic visits. Patients who received telephone-care made fewer scheduled and unscheduled visits to the clinic and were treated with fewer medications than those who received usual-care. Patients in the telephone-care group were admitted to the hospital less often and had shorter stays in the hospital, compared to patients in the usual-care group. Total costs for medical care for the patients who received telephone care were $4,299 Compared to $5,955 spent on those who received the usual care. Functional improvement, survival and cost reduction were greater in the patients receiving telephone care who had poorer health.

Utilization review of a radiology service may not necessarily reduce the ordering of X-rays, CT, MRI and ultrasound scans. Utilization review is used by managed care organizations to reduce unnecessary tests. At one university hospital, researchers tested utilization review by requiring all diagnostic radiology scans to be approved by a consulting radiologist. The use of resources in this group was compared to a group that did not use utilization review. Utilization review did not reduce the number of scans ordered, nor did it reduce the number of patient examinations or length of hospital stay.

Author: Katz, Steven J., Bree, Robert L., Kazerooni, Ella A.

Publisher:American Medical AssociationPublication Name:JAMA, The Journal of the American Medical AssociationSubject:HealthISSN:0098-7484Year:1996